Revista Espanola de Enfermedades Digestivas (Dec 2007)
Calprotectina fecal como marcador diferencial entre patología gastrointestinal orgánica y funcional Fecal calprotectin as a biomarker to distinguish between organic and functional gastrointestinal disease
Abstract
Introducción: la determinación de calprotectina en heces se está afianzando en los últimos años como un marcador no invasivo para el diagnóstico diferencial entre patología gastrointestinal orgánica y funcional. Su uso es útil sobre todo en niños que requieren anestesia general para una colonoscopia. El objetivo de este estudio es evaluar la sensibilidad y utilidad de la calprotectina fecal (CPF) en pacientes pediátricos con signos y síntomas sugestivos de enfermedad inflamatoria intestinal (EII) con el fin de evitar técnicas invasivas innecesarias y poder discriminar entre patología gastrointestinal orgánica y funcional. Material y métodos: se determinó la concentración de calprotectina mediante enzimoinmunoanálisis en una única muestra de heces de 47 niños (edad media: 10,1 años) con algún síntoma de patología gastrointestinal sugestivo de organicidad. Trece niños fueron diagnosticados de patología funcional y 34 de patología orgánica. Entre estos, 15 con EII y el resto con patologías orgánicas de distinto origen (no-EII). Se incluyeron 13 niños sanos como controles. Resultados: el grupo de niños con EII presentó valores de CPF [mediana (rango interquartil); 1.219 mg/g (322-2.967)] significativamente más altos que el grupo con patología gastrointestinal funcional [20 mg/g (16-25); p Introduction: there is growing evidence showing the importance of the fecal calprotectin assay in differentiating organic from functional gastrointestinal disease. It is a simple, non-invasive biomarker that is especially useful in children, who may require general anesthesia for colonoscopy. The aim of this study was to assess the use and sensitivity of fecal calprotectin (FCP) in pediatric patients with signs and symptoms of IBD to avoid unnecessary invasive techniques and to distinguish between organic and functional gastrointestinal pathology. Material and methods: a single stool sample was collected from 47 children (mean age: 10.1 years) referred for non-specific gastrointestinal symptoms suggestive of organicity. On the basis of clinical criteria 13 children had functional bowel disorders and 34 had organic gastrointestinal disease, 15 with IBD and 19 with other organic (non-IBD) gastrointestinal conditions. Thirty healthy children were included as controls. Calprotectin concentrations were measured by enzyme immunoassay. Results: children with IBD had FCP levels [median (interquartile range); 1,219 μg/g (322-2,967 μg/g)] higher than children with functional gastrointestinal disease [20 μg/g (16-25 μg/g); p < 0.0001], those with organic non-IBD disease [113 μg/g (36-193 μg/g); p = 0.002], and healthy children [25 μg/g (19.2-32.5 μg/g); p < 0.0001]. Fecal calprotectin concentration also was significantly higher in children with organic (non-IBD) disease as compared to controls (p = 0.004) and children with functional pathology (p = 0.002). FCP levels were similar in controls and children with functional gastrointestinal disease (p = 0.264). Discussion: CPF is a sensitive, but not disease-specific, marker to identify patients with IBD who should undergo diagnostic colonoscopy, and to avoid unnecessary invasive procedures in patients with functional gastrointestinal disorders.
